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Immediate and one-year outcome of patients presenting with Acute Coronary Syndrome complicated by stroke: Findings from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2)

Jassim Al Suwaidi113*, Khalid Al Habib2, Nidal Asaad1, Rajvir Singh3, Ahmad Hersi2, Husam Al Falaeh4, Shukri Al Saif5, Ahmed Al-Motarreb6, Wael Almahmeed7, Kadhim Sulaiman8, Haitham Amin9, Jawad Al-Lawati10, Norah Q Al-Sagheer11, Alawi A Alsheikh-Ali127 and Amar M Salam1

Author Affiliations

1 Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar

2 King Fahad Cardiac Center, King Khalid University Hospital, College of Medicine, Riyadh, Saudi Arabia

3 Department of Research, Hamad Medical Corporation (HMC), Doha, Qatar

4 Security Forces Hospital, Riyadh, Saudi Arabia

5 Saud AlBabtain Cardiac Center, Dammam, Kingdom of Saudi Arabia

6 Faculty of Medicine, Sana’s University, Sana’a, Yemen

7 Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates

8 Department of Cardiology, Royal Hospital, Muscat, Oman

9 Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain

10 Department of Non-Communicable Diseases Surveillance and Control, Ministry of Health, Muscat, Oman

11 Cardiac Center, Al-Thawra Hospital, Sana’a, Yemen

12 Institute for Clinical Research and Health Policy Studies and Department of Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA

13 Department of Adult Cardiology, Heart Hospital, Hamad General Hospital (HMC), P.O Box 3050, Doha, Qatar

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BMC Cardiovascular Disorders 2012, 12:64  doi:10.1186/1471-2261-12-64

Published: 16 August 2012



Stroke is a potential complication of acute coronary syndrome (ACS). The aim of this study was to identify the prevalence, risk factors predisposing to stroke, in-hospital and 1-year mortality among patients presenting with ACS in the Middle East.


For a period of 9 months in 2008 to 2009, 7,930 consecutive ACS patients were enrolled from 65 hospitals in 6 Middle East countries.


The prevalence of in-hospital stroke following ACS was 0.70%. Most cases were ST segment elevation MI-related (STEMI) and ischemic stroke in nature. Patients with in-hospital stroke were 5 years older than patients without stroke and were more likely to have hypertension (66% vs. 47.6%, P = 0.001). There were no differences between the two groups in regards to gender, other cardiovascular risk factors, or prior cardiovascular disease. Patients with stroke were more likely to present with atypical symptoms, advanced Killip class and less likely to be treated with evidence-based therapies. Independent predictors of stroke were hypertension, advanced killip class, ACS type –STEMI and cardiogenic shock. Stroke was associated with increased risk of in-hospital (39.3% vs. 4.3%) and one-year mortality (52% vs. 12.3%).


There is low incidence of in-hospital stroke in Middle-Eastern patients presenting with ACS but with very high in-hospital and one-year mortality rates. Stroke patients were less likely to be appropriately treated with evidence-based therapy. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.

Acute coronary syndrome; Myocardial infarction; Stroke; Risk factors; Prognosis